Suture passing device

ABSTRACT

A suture passing device includes a jaw assembly that is moved to an open configuration after exiting a hollow needle distal tip and moved to a closed configuration when retracted into the needle tip. The jaw assembly may include a pair of jaw members biased to a default diverging configuration. A suture capturing mechanism formed on the jaw members securely captures suture to both push and pull the captured when the jaw assembly is retracted into the hollow distal tip. The device may also include a second suture capturing mechanism that loosely captures suture and enables the captured suture to slide.

CROSS-REFERENCE TO RELATED APPLICATION(S)

This application is a continuation of U.S. patent application Ser. No.16/400,681, filed May 1, 2019, which claims benefit of U.S. ProvisionalApplication No. 62/667,021 filed on May 4, 2018, and U.S. ProvisionalApplication No. 62/689,388 filed on Jun. 25, 2018, which are herebyincorporated by reference herein in their entirety.

BACKGROUND OF THE INVENTION 1. Field of the Invention

The present invention relates in general to medical devices. Moreparticularly, the invention is directed to a suture passer.

2. Description of Prior Art and Related Information

Often times an important aspect of a surgical procedure is to passsuture through tissue. This could be required to mend a tear or connecttwo or more pieces of soft tissue. Though this task is common it can bechallenging for the surgeon especially in an arthroscopic procedurewhere visualization is limited.

Many devices have been created to address difficult suturing scenariosbut there are still certain procedures and anatomies where the averagesurgeon still struggles. For example, suturing the labrum at times canprove challenging particularly when the tissue is severely damaged. Insuch cases decreasing the overall profile of the feature penetrating thetissue and optimizing the working profile of the instrument to improveaccess to the working site can be critical factors to facilitatesuturing.

Within this smaller needle profile, a mechanism must be housed thatallows easy passing and retrieving of suture by the doctor in anarthroscopic atmosphere. With many devices currently on the market avery small loop of suture is provided during tissue passing such thatthe surgeon is challenged to hit the miniscule target and retrieve thesuture.

A device is required that easily passes suture through tissue andprovides a large amount of suture on the other side of the tissue thatwill be relatively easy for the surgeon to grab and pull out of thearthroscopic portal. This system must also be relatively simple so thatthe manufacturing cost can be kept at a reasonable level.

SUMMARY OF THE INVENTION

In one aspect, a suture passing device is provided. The device comprisesa handle and a shaft coupled to the handle. The shaft comprises a sharpdistal tip that defines a shaft axis. The shaft defines a lumen.

A jaw assembly is housed within the shaft. The jaw assembly comprises afirst jaw member and a second jaw member. The first jaw member and thesecond jaw member are movable with respect to each other between aclosed position and an open position. The jaw assembly comprising apush-pull suture capturing mechanism. An actuating mechanism is coupledto the jaw assembly and configured to move the jaw assembly between theclosed position and the open configuration.

The first jaw member and the second jaw member are biased away from eachtowards the open position and moved to the open position when theactuator moves the jaw assembly distally with respect to the shaft suchthat first jaw member and the second jaw member each diverge from theshaft axis when exiting the shaft. The first jaw member and the secondjaw member are moved to the closed position when the actuating mechanismis moved to retract the jaw assembly proximally with respect to theshaft.

The suture capturing mechanism may preferably comprise teeth. The suturecapturing mechanism may comprise a first plurality of pointy teethincluded in the first jaw member to form a first scalloped edge, and asecond plurality of pointy teeth included in the second jaw member toform a second scalloped edge. The first plurality of teeth maypreferably be nestable with the second plurality of teeth when the jawassembly is in the closed configuration.

The shaft may comprise a bent shaft portion.

The sharp distal tip may comprise a blade tip at the distal end. Adistal end of the jaw assembly may be retracted into the shaft in apreferred range of 10 mm to 45 mm from the blade tip.

The device may further comprise a stacked jaw assembly where a third jawmember stacked on and movable in unison with the first jaw, and a fourthjaw member stacked on and movable in unison with the second jaw.

The jaw assembly may further comprise a second loose suturing capturingmechanism.

The jaw assembly may further comprise a cutout proximal to the suturecapturing mechanism.

The jaw assembly may preferably comprise a thickness in the range of 0.4mm to 4.0 mm.

The jaw assembly comprises an exterior and the shaft comprises aninterior shaft surface, and a gap between the exterior of the jawassembly and the interior shaft surface is less than 1 mm.

In a further aspect, a suture passing device is provided having a jawassembly comprising a push-pull suture passing mechanism. The devicecomprises a handle and a shaft coupled to the handle. The shaftcomprises a sharp distal tip that defines a shaft axis. The shaftdefines a lumen.

A jaw assembly is housed within the shaft. The jaw assembly comprises afirst jaw member and a second jaw member. The first jaw member and thesecond jaw member are movable with respect to each other between aclosed position and an open position.

An actuating mechanism is coupled to the jaw assembly and configured tomove the jaw assembly between the closed position and the openconfiguration. The first jaw member and the second jaw member are biasedaway from each towards the open position and moved to the open positionwhen the actuating mechanism moves the jaw assembly distally withrespect to the shaft such that first jaw member and the second jawmember each diverge from the shaft axis when exiting the shaft. Thefirst jaw member and the second jaw member are moved to the closedposition when the actuating mechanism is moved to retract the jawassembly proximally with respect to the shaft. The push-pull suturecapturing mechanism comprises a set of teeth formed on at least one ofthe first jaw member and second jaw member.

The shaft may comprise a bent shaft portion.

The jaw assembly may comprise a second loose suturing capturingmechanism.

The jaw assembly may comprise a cutout proximal to the push-pull suturecapturing mechanism.

The device may comprise a stacked jaw assembly where a third jaw memberis stacked on the first jaw and a fourth jaw member is stacked on thesecond jaw. The third jaw and the fourth jaw preferably converge anddiverge from each other in unison with the first jaw and second jaw.

In a further aspect, a suture passing device is provided having astacked jaw assembly minimizing jaw movement within a shaft in which thejaw assembly is housed. The shaft is coupled to a handle. The shaftcomprises a sharp distal tip that defines a shaft axis. The shaftdefines a lumen. A dual-stack jaw assembly housed within the shaftcomprises a first pair of jaw members and a second pair of jaw membersstacked on the first pair of jaw members to form a first jaw memberstack and a second jaw member stack. The first jaw member stack and thesecond jaw member stack are movable with respect to each other between aclosed position and an open position. The jaw assembly comprises apush-pull suture capturing mechanism.

An actuating mechanism is coupled to the jaw assembly and configured tomove the jaw assembly between the closed position and the openconfiguration. The first jaw member stack and the second jaw memberstack are biased away from each towards the open position and moved tothe open position when the actuating mechanism moves the jaw assemblydistally with respect to the shaft such that first jaw a member stackand the second jaw member stack each diverge from the shaft axis whenexiting the shaft. The first jaw member stack and the second jaw memberstack are moved to the closed position when the actuating mechanism ismoved to retract the jaw assembly proximally with respect to the shaft.

The first jaw member comprises a first set of teeth configured tocapture suture and the second jaw member comprises a second set of teethconfigured to capture suture.

The shaft comprises a cutout proximal to the jaw assembly.

The push-pull suture capturing mechanism preferably comprises ascalloped edge.

Methods of passing suture are also provided.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is a top perspective view of a suture passing device according tofirst preferred embodiment.

FIG. 2A is a perspective view of the first preferred embodiment of thesuture passing device with jaw assembly in an open configuration.

FIG. 2B is a perspective view of the first preferred embodiment of thesuture passing device with jaw assembly in a partially retractedconfiguration.

FIG. 2C is a perspective view of the first preferred embodiment of thesuture passing device with jaw assembly in a further retractedconfiguration.

FIG. 2D is a perspective view of the first preferred embodiment of thesuture passing device with jaw assembly in a retracted, closedconfiguration.

FIG. 3A is a perspective view of the first preferred embodiment of thesuture passing device with jaw assembly in an open configuration toreceive suture.

FIG. 3B is a perspective view of the first preferred embodiment of thesuture passing device with jaw assembly in a partially retractedconfiguration to begin grasping suture.

FIG. 3C is a perspective view of the first preferred embodiment of thesuture passing device with jaw assembly in a closed configuration tocapture suture.

FIG. 3D is a perspective view of the first preferred embodiment of thesuture passing device with jaw assembly in a fully retracted, closedconfiguration carrying suture within the distal tip.

FIG. 4A is a perspective view of the first preferred embodiment of thesuture passing device carrying suture prior to penetrating tissue.

FIG. 4B is a perspective view of the first preferred embodiment of thesuture passing device penetrating tissue with the carried suture.

FIG. 4C is a cross-sectional perspective view showing the firstpreferred embodiment of the suture passing device in the positionillustrated in FIG. 4B;

FIG. 4D is a perspective view of the first preferred embodiment of thesuture passing device releasing suture after being carried throughtissue.

FIG. 4E is a perspective view of the first preferred embodiment of thesuture passing device penetrating tissue to grasp a loop section of thesuture.

FIG. 5A is a top plan view of the first preferred jaw assembly.

FIG. 5B is a side elevation view of the first preferred jaw assembly.

FIG. 5C is a cross-sectional view of the first preferred jaw assemblytaken along lines 5C-5C of FIG. 5A.

FIG. 6 is a top plan view of an alternative embodiment of a jawassembly.

FIG. 7 is a top plan view of a further alternative embodiment of a jawassembly.

FIG. 8A is a top plan view of a further alternative embodiment of a jawassembly.

FIG. 8B is a top plan view of a further alternative embodiment of a jawassembly.

FIG. 8C is a top plan view of a further alternative embodiment of a jawassembly.

FIG. 9A is a top plan view of a further alternative embodiment of a jawassembly.

FIG. 9B is a top plan view of a further alternative embodiment of a jawassembly.

FIG. 9C is a top plan view of a further alternative embodiment of a jawassembly.

FIG. 10A is a cross-sectional view of an alternative embodiment of aribbon of a jaw assembly.

FIG. 10B is a cross-sectional view of an alternative embodiment of aribbon of a jaw assembly.

FIG. 10C is a cross-sectional view of an alternative embodiment of aribbon of a jaw assembly.

FIG. 10D is a cross-sectional view of an alternative embodiment of aribbon of a jaw assembly.

FIG. 10E is a cross-sectional view of an alternative embodiment of aribbon of a jaw assembly.

FIG. 11A is a cross-sectional view of an alternative embodiment of aribbon of a jaw assembly.

FIG. 11B is a cross-sectional view of an alternative embodiment of aribbon of a jaw assembly.

FIG. 12 is a top plan view of an alternative embodiment of a jawassembly.

FIG. 13 is a top plan view of an alternative embodiment of a jawassembly.

FIG. 14 is a top plan view of an alternative embodiment of a jawassembly.

FIG. 15 is a top plan view of an alternative embodiment of a jawassembly.

FIG. 16 is a top plan view of an alternative embodiment of a jawassembly.

FIG. 17 is a top plan view of an alternative embodiment of a jawassembly.

FIG. 18 is a perspective view of an alternative embodiment of a jawassembly.

FIG. 19 is a top plan view of an alternative embodiment of a jawassembly.

FIG. 20 is a top plan view of an alternative embodiment of a jawassembly.

FIG. 21 is a perspective view of an alternative embodiment of a jawassembly.

FIG. 22 is a perspective view of an alternative embodiment of a jawassembly.

FIG. 23 is a top plan view of an alternative embodiment of a jawassembly.

FIG. 24 is a perspective view of an alternative embodiment of a jawassembly.

FIG. 25 is a top plan view of an alternative embodiment of a jawassembly.

FIG. 26 is a perspective view of a second preferred embodiment of asuture passing device.

FIG. 27 is a perspective view of a third preferred embodiment of asuture passing device.

FIG. 28 is a perspective view of a fourth preferred embodiment of asuture passing device.

FIG. 29 is a perspective view of a fifth preferred embodiment of asuture passing device.

FIG. 30 is a perspective view of a sixth preferred embodiment of asuture passing device.

FIG. 31 is a perspective view of an alternative embodiment of a distalneedle tip having a curve.

FIG. 32 is a perspective view of a seventh embodiment of a suturepassing device.

FIG. 33 is a diagram of a preferred method of passing suture.

FIG. 34 is a diagram of a further preferred method of passing suture.

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS

The following preferred embodiments, in general, are directed to devicesand methods for manipulating and passing suture. As will be appreciated,aspects of the suture passing device and its embodiments provideconvenience for grasping suture and passing captured suture throughtissue. Moreover, aspects disclosed are useful and superior toconventional suture passing devices because the preferred elementsprovide a reliable and more convenient capture of sutures. In general,preferred devices are disclosed which include a jaw assembly having asuture capturing mechanism that securely pushes and pulls a capturedsuture. It will be understood that the embodiments disclosed may includedifferent jaw assemblies and suture capturing mechanisms in combinationand no one jaw assembly is necessarily operated with any particularsuture capturing mechanism disclosed. Thus, enumeration in the followingdoes not imply that a jaw assembly with the same number series must beoperated by a suture capturing mechanism of the same number series.

Referring now to FIG. 1, a first preferred embodiment of a suturepassing device or suturing device 10 is shown. The device 10 preferablycomprises a proximal portion 20 and a distal portion 22. The proximalportion 20 includes a handle 24 and an actuating mechanism which maycomprise a thumb slide 26. The thumb slide 26 communicates with andactuates a jaw assembly 30 included in the distal portion 22 of thedevice 10. An actuator (not shown) is coupled to the thumb slide and thejaw assembly 30 which is housed in a shaft 32. The shaft 32 defines ashaft axis A.

The device 10 comprises a distal tip 34. In the preferred embodiment,the distal tip 34 comprises a sharp needle tip. While the distal tip 34is shown in a straight configuration for simplicity, it should beexpressly understood that this tip can be bent in a number of differentcurves as required.

In FIG. 2A, a close-up of the first preferred distal needle tip 34 isshown with the jaw assembly 30 in a default open configuration when theactuating mechanism 26 of FIG. 1 is moved distally. The distal tip 34may comprise a sharpened distal blade that enhances its ability topuncture tissue. In the first preferred embodiment, the jaw assembly 30preferably comprises a pair of jaw members, or first and second jawmembers, 41. In the preferred embodiment, the full length of the firstand second jaw members 41 can range from 2 mm to 15 mm or longerdepending on the amount of spread and reach desired for suturemanipulation.

The jaw assembly 30 comprises a push-pull suturing capturing mechanism44 preferably formed on the pair of jaw members 41. In the firstpreferred embodiment, the suture capturing mechanism 44 may comprise aseries of valleys 45 and teeth 46 formed on each jaw member 41 in apreferably alternating pattern. In the preferred embodiment, the heightof the teeth 46, or depth of the valleys 45 can range from 0.1 mm to 5mm depending on the constraining tube diameter and suture to bemanipulated. The number of valleys 45 and teeth 46 can vary from one tomultiple quantities. The number of valleys 45 need not match the numberof teeth 46. And the configuration on one jaw member 41 relative to theother opposite jaw member 41 can mesh as shown in the illustratedembodiment, comprise a mirror image (which would not mesh) or interactin a more random manner. Each jaw member 41 can also have a differentpattern relative to the other jaw member 41 such as staggered teeth. Asa further example, one jaw member 41 may comprise a flat face, i.e. novalleys or teeth, while the opposite jaw member 41 comprises valleys andteeth.

In the preferred embodiment, the push-pull suture capturing mechanism 44is configured to both push and pull a captured portion of suture. Thesuture capturing mechanism 44 may accomplish this dual push-pull actionby having, for example, teeth 46 that affix to and lock on a specificpoint of suture. That fixed point of suture may be both pulled—e.g.,when the jaw assembly 30 is retracted into the into hollow shaft 32—andpushed—e.g., when the jaw assembly 30 exits out the shaft carrying theaffixed point of suture until the jaw members 41 diverge from each otherso as to release the suture.

In the preferred embodiment, the jaw assembly 30 may preferably becomposed of a variety of materials including plastic and/or metal. Onepreferred material may be Nitinol which can be shape-set in thespread-out configuration as shown in FIG. 2A. In the illustratedembodiment, the jaws may be preconfigured to a default spread-apartconfiguration shown in FIG. 2A when at rest and can be brought togetheras in FIG. 2D without yielding the material. In the first preferredembodiment, there are no hooks located at the distal ends of the jaws.

In the default open position of the jaw assembly 30 as shown in FIG. 2A,the first and second jaws 41 diverge away from the shaft axis A, andthus diverge away from each other 41. When the jaws 41 are moveddistally to exit the distal tip 34, the jaws 41 are biased to thisflared-out open configuration where neither jaw 41 is parallel to theshaft axis A.

In FIGS. 2B, 2C, and 2D, the jaw assembly 30 is being drawn in to alumen 50 defined within the shaft 32 when the actuating mechanism 26shown in FIG. 1 is moved proximally. As shown in FIG. 2B, an inner wall52 of the shaft 32 slowly forces the two jaw members 41 together as thejaw assembly 30 is retracted into the distal tip 34 and further into theshaft 32. The inner wall 52 causes the pair of jaw members 41 toconverge towards each other as the jaw assembly 30 is drawn into lumen40. In FIG. 2D, the jaw assembly 30 is retracted into distal tip 34 andmoved to a closed configuration when the actuating mechanism is movedfurther proximally. The inner wall 52 is preferably abutting not onlyone jaw member 41, but both jaw members 41 to cause the pair of jawmembers 41 to converge when retracted into the shaft 32. This isaccomplished in part to the default shape of each jaw 41 which ispreferably biased away (i.e., opposite direction) from the opposing jaw41 as shown in FIG. 2A.

In the first preferred embodiment where similar geometries are formed oneach jaw member 41, this convergence can be likened to two sets of teethmeshing in a zipper-type action when retracted into the shaft 32. In theillustrated embodiment, it should be noted that the jaw members 41 areshown coming together on the same plane but it is a common occurrencefor jaw members 41 to come in to the distal tip 34 at slightly differentplanes especially if suture is also being pulled in. Also, the two jawmembers 41 not need be symmetrical. For example, one jaw member could becurved as shown and the other jaw member relatively straight.

In the preferred embodiment shown in FIG. 2D, the device 10 comprises akerf 57 that forms a space between the two jaw members 41 which can varyfrom touching to a distance capable of holding a particular suture of adesired size. This gap can be as large as 0.5 mm and still hold some ofthe larger suture sizes. For smaller suture sizes this gap will often becloser to a range between 0 mm and 0.25 mm. In the preferred embodiment,the distal end 58 of the jaw assembly 30 may be retracted into the shaft32 in a preferred range of 10 mm to 45 mm from the blade tip 36.

FIGS. 3A-3D illustrate operative views of the preferred suturing device10. FIG. 3A shows the deployed jaw assembly 30 extending distally outfrom the shaft 32 and surrounding a piece of suture 62 with a widecapture space, or region 63 that is generally shaped as a flared-outfunnel or flared-out horn. In this deployed configuration, the jawmembers 41 are extended distally out of the shaft 32 and positioned onopposite sides of the suture 62 in their default divergentconfiguration. The jaw members 41 are biased to a divergingconfiguration when deployed and moved to a converging configuration whenretracted into the tube 32. The spread of the distal jaw tips 43 will bedependent on what the nearby anatomy of the patient will allow, but theability to spread between 5 and 10 mm will be desired in most instances.In this default diverging configuration shown in FIG. 3A, the jawmembers 41 are preferably flared out such that the distance betweencounterpart portions of the jaw members 41 increases starting from theproximal jaw portion 59 to the distal jaw portion 58. This flared-outconfiguration between the jaw members 41 creates a wide capture spacefor receiving a suture to be captured.

In FIG. 3B, the jaw assembly 30 is partially drawn into the shaft 32which pushes the jaw members 41 towards each other to capture the suture62. In particular, the inner wall 52 of the shaft 32 causes the jaws 41to converge as the jaw assembly 30 is retracted into the lumen 50. Thesuture 62 is retracted further in FIG. 3C which illustrates a closedconfiguration of the jaw assembly 30 wherein the jaws 41 abut eachother. In this closed position in FIG. 3C, the suture 62 is captured asa fixed point 64 of suture 60 is locked between the valleys 45 and teeth46 of the jaw members 41. In the preferred embodiment, the capturedportion of suture 62 may be retracted into the lumen 50 in a preferredrange of 10 mm to 45 mm from the distal tip 34.

In FIG. 3D, the closed jaw assembly is further retracted into the shaft32 carrying the suture 62 further within the distal tip 34. It should benoted that the suture 62 can be pulled in a relatively long distancesuch that when the suture 62 is pushed out, a large loop can be formedwith the deployed length. This length could be 10 mm to 45 mm, or more.The captured suture portion 62 is pushed out by virtue of the suturecapturing mechanism (disposed within the shaft in FIG. 3D) locking ontoa fixed point of suture and carrying the affixed point of capturedsuture in a distal direction. This push dynamic is distinguishable fromprior art jaw assemblies that loosely hook onto a suture and thus cannotdistally push a fixed point of suture.

FIGS. 4A-4E show a preferred method for passing suture 62 with the firstpreferred embodiment of the suturing device 10. In FIG. 4A, the suture62 has been loaded in the passer 10 as shown in FIG. 3D. In FIG. 4B, thesharp distal tip 34 is pushed through the tissue 66 carrying at leastportion of suture 62 through the tissue 66.

In the retracted position shown in FIG. 4C, the jaw assembly 30 carriesthe captured suture portion 62 into the shaft 32 for a preferreddistance in the range of 10 mm to 45 mm measured from the blade tip 36end of the distal tip 34. In the preferred embodiment, the suturecapturing mechanism 44 locks onto a fixed point 64 of suture 62 anddistally pushes this affixed point 64 of suture 62 when the jaw assembly30 is translated distally with respect to the shaft 32. Jaw mechanismsconfigured to lock onto a fixed point of suture may compriseteeth/valley combinations as discussed above, and a variety of grippingor securing jaw combinations as discussed below in reference to FIGS.8A-31, except FIG. 14.

In FIG. 4D the jaw assembly 30 is deployed out the tip 34 so that thejaw members 41 push and pull the suture 62 out of the tip 34 and releasea large suture loop 67 once the proper spread is achieved between thejaw members 41. This leaves the large loop 67 that can easily be grabbedby the passer 10 once it has adjusted to a new position as shown in FIG.4E. It should be noted that an addition or variation to this method isto pierce the tissue 66 with a distal tip 34 that is not loaded withsuture. The jaw assembly 30 can then grab the suture 62 on the otherside of the tissue 66 similar to FIG. 4E.

FIG. 5A illustrates details of the preferred jaw assembly 30 having asuture capturing mechanism 44 that prevents or inhibits captured suturefrom sliding. For machining purposes there may be a witness kerf 57.This acts to form the pattern of teeth 45 and valleys 46 between the twojaw members though the two jaws do not necessarily have to nest as shownin the illustrated embodiment. Also, the kerf 57 can vary in width overits length to create smaller or larger gaps between the two jaws 41.

In FIG. 5A, the jaw assembly 30 may preferably comprise thinned sections68 with cutouts 70 that allow for the pair of jaws 41 to bend outwardsaway from each other bend outwards (as shown in FIG. 3A) or inwards withminimal imparted stresses as shown in FIG. 3A. This diverging motion isrepresented in FIG. 5C with movement arrows 79 indicating that the jawassembly 30 as a whole is more flexible along the plane shown in FIG.5C. The thinned sections 68 shown in FIG. 5A also provide greaterflexibility for the jaw assembly 30 to bend as indicated by the movementarrows 77 in FIG. 5B. The thinned sections 68 also allow for twisting ofthe jaw assembly 30 under torsion forces, thereby allowing the jawassembly 30 to pass through non-linear tubes that may be bent inmultiple planes. Referring back to FIG. 5A, the thinned sections 68 arepreferably located proximal to suture capturing mechanism 44 andcollectively form a void 71 when the suture capturing mechanism is inthe closed position as shown. For proper flexibility without impartingyielding stresses, the length and displacement must be taken intoaccount but in general the thickness can preferably range from 0.2 mm to2 mm.

And for jaw assemblies 30 composed of memory materials such as Nitinolthe thinned sections 68 allow for shape set in an open position. Theproximal relief is a feature that minimizes the stress on the part whenthe jaw members 41 are displaced. In the first preferred embodiment, thejaw members 41 preferably comprise distal portions of a unitary jawstructure 30. Thinned sections 68 are shown to have uniform crosssection along their length but this cross-section area may vary overthat length in order to evenly distribute stresses during bending. Forinstance, the cross-sectional area of the thinned section 68 candecrease as it gets closer to the teeth 46 in a way to even out stressesduring bending.

A 90° view of FIG. 5A is shown in FIG. 5B. It is obvious that thisaspect is much thinner than that of FIG. 5A which allows for relativeflexure ease as shown with arrows 77 while minimizing imparted stresses.Another view of the relative planar thicknesses is shown in FIG. 5C.

In the following alternative embodiments, elements of similar structureare designated by the same reference numerals followed by at least onelower case letter (e.g., jaw assembly 30 b)

FIGS. 6-10E illustrate alternative embodiments of the jaw assembly, eachhaving a preferred suture capturing mechanism configured to lock onto apoint of suture and both push and pull the affixed point of suture.

FIG. 6 shows an alternative embodiment of the jaw assembly 30 bcomprising teeth 46 b that need not be rectangular but can be curved orround as shown. The teeth can also be triangular, or a combination ofdifferent shapes as shown in the following embodiments.

FIG. 7 illustrates a jaw assembly 30 c comprising an axial slit 72 thatmakes the jaw ribbon 74 more flexible. This allows for the two halves 76of the ribbon 74 to move independently while keeping most of thecompressive and tensile properties of the ribbon 74. This becomes mostimportant when the ribbon 74 is moving through constraining componentsthat have bends in multiple axis.

FIG. 8A illustrates a jaw assembly 30 d having a second suture capturemechanism 78 that enables suture to slide once it has been captured. Thegentle geometry of the cutout distal curve 78 can be positioned suchthat the suture captured by the jaw assembly 30 d will slide within thecurve 78 when the device pulls on the suture. In the configurationshown, access 84 to the kerf 57 d is proximal to the distal-most portion82 of the curve 78 such that the suture would tend to settle in to thecurve 78 when the suture is moved distally with respect to the jawassembly 30 d (i.e., when the jaw assembly 30 d is retractedproximally). This prevents the suture from getting stuck in the kerfaccess 84. The cutout distal curve 78 thus comprises a hook 78 thatenables captured suture to slide transversely (i.e., in and out of thepage in the view of FIG. 8A) with respect to the jaw assembly 30 d.Thus, the jaw assembly 30 d comprises two suture capture mechanisms 44d, 78: namely, a first push-pull suture capturing mechanism 44 d thatlocks onto a fixed point of suture and a second loose suture capturingmechanism 78 that captures suture while allowing the capture suture toslide.

In FIG. 8B, the cutout 70 e of the jaw assembly 30 e defines a distalcutout curve, or hook, 78 e positioned even more distally with respectto the kerf access 84 e. In comparison to the jaw assembly 30 d shown inFIG. 8A, the kerf access 84 e in FIG. 8B is positioned more proximallywith respect to the hook 78 e. The jaw assembly 30 e thus comprises afirst push-pull suture capturing mechanism 44 e that locks onto a fixedpoint of suture and a second loose suture capturing mechanism 78 e thatallows captured suture to slide.

In FIG. 8C, the cutout 70 f of the jaw assembly 30 f defines two distalcutout curves, or hooks, 78 f positioned distally to the kerf access 84f, which enables the captured suture to seat in to either of the hooks78 e and away from the kerf access 84 f. The jaw assembly 30 f thuscomprises a first push-pull suture capturing mechanism 44 f that locksonto a fixed point of suture and a second loose suture capturingmechanism 78 f having two hooks that allow captured suture to slide.

FIGS. 9A-9C show alternative embodiments of the push-pull suturecapturing mechanism having asymmetrical patterns of teeth and valleys,namely, where the pattern on a first jaw is not symmetrical to thepattern on the opposing second jaw. The teeth themselves can have aconsistent or varying width and height along the length of the jaws. Thenumber of teeth can also vary from one to more than one.

In FIG. 9A, the suture capturing mechanism 44 g may comprise teeth 46 gon only one jaw 41 g-1 with the second jaw 41 g-2 having a relativelyflat jaw surface 86.

In FIG. 9B, the suturing capturing mechanism 44 h comprises a first jaw41 h-1 with a first geometry of teeth 45 g-1 while a second jaw 41 h-2comprises a different second geometry of teeth 45 g-2.

In FIG. 9C, the suturing capturing mechanism 44 i comprises differenttooth geometries within the same jaw 41 i-1, 41 i-2. For example, thefirst jaw 41 i-1 may have both rectangular and triangular teeth 46 i-1.Similarly, the second jaw 41 i-2 may itself have differently shapedteeth.

FIGS. 10A-11B illustrate different cross-sectional profiles of preferredribbons. FIG. 10A shows a ribbon 74 j having a circular profile. FIG.10B illustrates a ribbon 74 k having a rectangular profile, which maycomprise a square. FIG. 10C illustrates a ribbon 74 l with a triangularprofile. FIG. 10D illustrates a ribbon 74 m having a hexagonal profile.FIG. 10E illustrates a ribbon 74 n having an oval profile.

FIG. 11A shows an assembly of two ribbons 74 o stacked on top of eachother lengthwise. FIG. 11B shows an assembly of two ribbons 74 p stackedon top of each other widthwise.

FIG. 12 illustrates a preferred jaw assembly 30 p where each jaw 41 pcomprises an alternating pattern of pointy teeth 46 p and curved valleys45 p to form a scalloped edge 80. In FIG. 12, the two scalloped edges 41p are staggered with respect to each other so as to nest at leastslightly when the jaws 41 p are closed.

FIG. 13 illustrates a pair of jaws 41 q with symmetrical scalloped edges80 q such that opposing pointy teeth 46 q contact each other when thepair of jaws 41 q is closed.

FIG. 14 illustrates a jaw assembly 30 r where a first jaw 41 r-1comprises a distal U-shaped hook structure 86 that defines a hook 78 rlocated distally to a distal end of the second jaw 41 r-2 whichcomprises a substantially flat surface 88. This illustrated embodiment30 r would allow captured suture to slide.

FIG. 15 illustrates a jaw assembly 30 s where a first jaw 41 s-1comprises a distal U-shaped hook structure 86 s that defines a hook 78 slocated distally to a distal end of the second jaw 41 s-2. Each jaw 41s-1, 41 s-2 comprises a scalloped edge 80 s that is preferably staggeredwith respect to the opposite edge. The jaw assembly 30 s thus comprisesa first push-pull suture capturing mechanism 44 e that locks onto afixed point of suture and a second loose suture capturing mechanism 78 sthat allows captured suture to slide. In the preferred embodiment ofFIG. 15, the loose suture capturing mechanism 78 s is preferably distalto the fixed suture capturing mechanism 44 s.

In any of the preferred embodiments disclosed herein having a loosesuture capturing mechanism, it may be preferable to bring the looselycaptured suture into the hollow shaft a preferred distance of 1 mm to 15mm from a blade tip of the distal tip.

FIG. 16 illustrates a jaw assembly 30 t where each jaw 41 t comprisestapered teeth 46 t and valleys 45 t with curved bases 90. A cutout 70 tlocated proximal to the suture capturing mechanism 44 t defines a hook78 t positioned distal to the kerf access 84 t. The jaw assembly 30 tthus comprises a first push-pull suture capturing mechanism 44 t thatlocks onto a fixed point of suture and a second loose suture capturingmechanism 78 t that allows captured suture to slide. In the preferredembodiment of FIG. 16, the loose suture capturing mechanism 78 t ispreferably proximal to the fixed suture capturing mechanism 44 t.

FIG. 17 illustrates a jaw assembly 30 u where each jaw 41 u comprisestapered teeth 46 u and valleys 45 u spaced apart from the counterpartteeth 46 u and valleys 45 u on the opposite jaw 41 u so as to form alarger kerf 57 u, namely, a greater gap or space between the medial edgeof a tooth 46 t and the base of the corresponding valley 45 u.

FIG. 18 illustrates a dual-stack jaw assembly 30 v that inhibitsunwanted jaw movement within the hollow shaft by filling up more ofspace therein with multiple pairs of jaw members 41 v stacked on oneanother. In this preferred embodiment, two pairs of jaw members 41 valong with corresponding ribbons 74 v are stacked upon each other so asto form a first jaw member stack 141-1 and a second jaw member stack141-2. The first and second jaw member stacks 141-1, 141-2 diverge fromeach other in the same manner as unstacked first and second jaw membersdo as described in the foregoing embodiments. The stacked jaw members ineach jaw member stack 141-1, 141-2 preferably move in unison.

The dual-stack jaw assembly 30 v may comprise two pairs of jaw membersthat are either discrete from each other or integral to each other. Ifdiscrete pairs of jaw members are stacked, each pair may be connected,adhered, fused or otherwise coupled to the other pair to form a stack.Alternatively, a dual-stack jaw assembly 30 v may comprise theequivalent of a discretely stacked pair of jaws by having a singleunitary pair of jaws with a greater thickness in the preferred range of0.4 mm to 4.0 mm. In the preferred embodiment, this inner diameter ofthe shaft may have a range of 0.75 mm to 2 mm. In the preferredembodiment, the jaw assembly has a thickness that reduces the gapbetween the exterior of the jaw assembly and the internal surface of theshaft, which distance is preferably between 0.2 mm to 1 mm. This stackedjaw assembly 30 v inhibits jaw movement within the shaft whilemaintaining the flexibility for the jaw members to move through thecurves of a shaft or tube.

According to the invention, a preferred suture passing device maycomprise a dual stack of any of the preferred jaw assemblies disclosedherein.

FIG. 19 illustrates a jaw assembly 30 w having multiple elongate cutouts70 w spaced apart along the jaw assembly axis. In this illustratedembodiment which preferably comprises three cutouts 70 w where thelength of a particular cutout can be made larger if increasedflexibility is required as shown in FIG. 19. One or more bridges 92 canthen be added to manipulate the flexibility of the jaw assembly as shownin FIG. 19. The bridges 92 can also be strategically placed to preventthe jaws from crossing within the hollow shaft, which is advantageous incurved tubes (see FIG. 32).

FIG. 20 illustrates a jaw assembly 30 x having distal elongate cutouts70 x-1 and a proximal elongate cutout 70 x-2 with a substantiallygreater axial length than that of the distal cutout 70 x-1. The distalelongate cutouts 70 x-1 collectively form a first void 71 x directlyproximal to the suture capturing mechanism 44 x and having a preferredlength of 4 mm to 20 mm including the suture capturing mechanism whenthe jaw assembly 30 x is closed. The proximal elongate cutout 70 x-2comprises a second void 70 x-2 with a preferred width in the range of0.03 mm to 0.75 mm and a preferred length in the range of 10 mm to 40mm.

FIG. 21 illustrates a cylindrical jaw assembly 30 y having four jawmembers 41 y that collectively form a cylinder. In particular, the jawassembly 30 y comprises a pair of top jaw members 41 y-t and a pair ofbottom jaw members 41 y-b. With some of these thicker cross-sectionssuch as the circle, the stiffness may become too great for bendingaround corners so it may be advantageous to make cuts 70 y-1 along afirst plane and additional cuts 70 y-2 along a second plane orthogonalto the first plane as shown in FIG. 21.

FIG. 22 illustrates a jaw assembly 30 z having a pair jaw members 41 zthat collectively form a cylinder. The jaw assembly 30 z comprises aplanar ribbon 74 z with a cutout 70 z proximal to the pair of jaws 41 z.FIG. 22 shows cuts made to removal material in the flexible section butleaving the round distal portion full to form a cylinder at the distalend of the jaw assembly 30 z. In both cases the extra cut is shown 90°to the original cut but it/they can be at any angle that leavessufficient material for the jaws' operation.

FIG. 23 illustrates a jaw assembly 30 aa that may be manufactured from arod as opposed to the ribbon associated with the foregoing embodiments.The jaw assembly 30 aa comprises curved valleys 45 aa and teeth 46 aa. Acutout 70 aa defines a hook 86 aa located distal to a kerf access 84 aa.

In FIG. 24, it will be appreciated that forming the jaw assembly 30 aamanufactured from a rod provides a more substantial three-dimensionaljaw body than the planar jaw assemblies of foregoing embodiments. Thisprovides the jaw assembly 30 aa with a jaw height or thickness 94 suchthat top indentations and bottom indentations 96, or grooves, may beformed in an alternating pattern with peaks 98. In this preferredembodiment, the top and bottom indentations 98 of a first jaw member 41aa are aligned with those 96 on the second jaw member 41 aa.

FIG. 25 illustrates a jaw assembly 30 bb manufactured from a rod havingtapered teeth 46 bb and tapered valleys 45 bb shaped to receive theteeth 46 bb to form a nesting relationship.

In FIG. 26, a second preferred embodiment of a suture passing device 10cc comprises a dual-stack jaw assembly 30 cc having two pairs of jaws 41cc-1, 41 cc-2 stacked on top of each other. In this preferredembodiment, a first pair of jaws 41 cc-1 is stacked on top of a secondpair of jaws 41 cc-2 to form a first jaw member stack 141 cc-1 thatdiverges away from a second jaw member stack 141 cc-2 in the openconfiguration. The second pair of jaws 41 cc-2 can be a replica of thefirst pair of jaws 41 cc-1.

FIG. 27 shows a third preferred embodiment of a suture passing device 10dd having a flattened or planar hollow shaft 32 dd to minimize unwantedjaw movement within when housing a planar jaw assembly 30 dd with aplanar jaw ribbon. It will be appreciated that the cross-sectionalribbon profiles shown in FIGS. 10A-10D may also aid in taking up openspace within the tube and minimize unwanted movement of the jaws.

FIG. 28 shows a fourth preferred embodiment of a suture passing device10 ee having a jaw assembly 30 ee where a first side portion 102comprises a single jaw member 41 ee-1 and a second side portion 104comprises a pair of stacked jaw members 41 ee-2. It will be appreciatedthat a jaw assembly 30 ee may comprise different and asymmetrical jawmembers.

FIG. 29 illustrates a fifth preferred embodiment of a suture passingdevice 10 ff where each jaw member 41 ff comprises a distal spacer 106that prevents unwanted jaw movement within the shaft 32 ff. Each jawmember 41 ff thus comprises dual distal tips stacked on each other. In apreferred embodiment, the spacers 106 may comprise teeth 108 and valleys110. Though the spacers are attached to the distal tip in thisillustrated embodiment, they can be attached anywhere along the lengthof the jaw assembly 30 ff to manipulate the movement within the shaft 32ff. Though it is not required that the stacked jaw assemblies beattached the resultant stiffness can be manipulated by strategicallyattaching the assemblies at various points along the length of theassembly. For example, attaching the assemblies at distal tips as shownin FIG. 29 and leaving the rest of the construct free would result in ajaw assembly with a stiffer tip. This design methodology can also beadvantageous to keep the distal tips pieces from crossing within thetube but allowing the shaft portion of the pieces to move relative toeach other and thus be more flexible. The opposite can also be done bywelding a portion of the shaft but not the jaw tips such that the shaftswill move together but the tips can move relative to each other for moreflexibility.

The advantage described in the above paragraph is most evident in curvedtubes (see FIG. 32) where relative position is important as isflexibility. Though the preferred means of attachment is laser weldingthere are a variety of methods that can be used to attach the jawassemblies such as a variety of adhesives.

FIG. 30 illustrates a sixth preferred embodiment of a suture passingdevice 10 gg where each jaw member 41 gg diverges linearly away fromeach along the distal direction, as opposed to foregoing embodimentswhere each jaw member increasingly diverges away from each along thedistal direction. Each jaw member 41 gg preferably comprises a scallopededge 80 gg.

FIG. 31 illustrates a seventh preferred embodiment of a suture passingdevice 10 hh having a jaw assembly 30 hh where each jaw 41 hh comprisesa first proximal bend 112 and a second distal bend 114. The first bend112 of each jaw 41 hh is diverging while the second bend 114 of each jaw41 hh is converging such that distal jaw portions 116 containing thesuture capturing mechanism 44 hh extend in a substantially parallelmanner when the jaw assembly 30 hh is in the open configuration as shownin FIG. 31.

FIG. 32 illustrates a curved hollow needle shaft 32 ii that may be usedwith any of the foregoing preferred embodiments of the suture passingneedle. The curved shaft 32 ii comprises a shaft bend 120 proximal tothe sharp needle tip 34 ii.

In all of the foregoing embodiments where the jaw assembly comprises aproximal ribbon portion, the ribbon may have a thickness in thepreferred range of 0.2 mm to 2 mm, and a width in the preferred range of1 mm to 2 mm.

In all of the foregoing embodiments where the jaw assembly comprises oneor more cutouts, the cutout may have a length in the preferred range of10 mm to 30 mm, and a width in the preferred range of 0.03 mm to 0.75mm.

In all of the foregoing embodiments where a preferred jaw assembly isshown in the closed configuration but without an accompanying shaft, itis to be expressly understood that the jaw members are shown closed forillustrative purposes only and that such Figures do not imply that thejaw assembly defaults to a closed configuration without a shaft.

It is to be expressly understood that a preferred suturing passingdevice according to the invention may comprise a dual stack of anyforegoing preferred jaw assemblies having any of the foregoing preferredsuture capturing mechanisms and any of the foregoing preferred cutouts.

A preferred method of passing suture 200 is also provided andillustrated in FIG. 33. The method 200 comprises the step 210 ofdiverging a pair of jaw members of a suture passing device from eachother by translating a jaw assembly distally with respect to a hollowshaft to cause the outwardly biased jaw members to exit a distal needletip. This step 210 creates a preferably flared-out capture space forreceiving a portion of suture. This steps 210 also comprises divergingeach of the jaw members away from an axis defined by the shaft.

In step 220, the suture passing device is moved to surround a suturewith the open jaw members. In step 220, the suture would be disposedwithin a suture capture space that is defined between the two divergingjaw members and preferably shaped as a funnel.

In step 230, the jaw assembly is retracted with respect to the tube suchthat the inner wall of the tube causes the jaw members to convergetoward each other.

In step 240, the jaw members are moved to a closed configuration so asto capture the suture and lock onto a fixed point of the suture toprevent sliding of the captured suture.

In step 250, the captured suture is retracted into the tube in apreferred range of 10 mm to 45 mm from a blade tip of the shaft.

In step 260, the captured suture is pushed out of the shaft by the jawmembers carrying a fixed point of suture to exit the shaft.

In step 270, the suture is released when the jaw members are moved to anopen configuration. In the preferred method, the suture is notimmediately released as soon as a distal portion of the jaw membersexits the shaft. Instead, the suture is preferably retained for a shortdistance of after the suture capturing mechanism exits the lumen of theshaft.

A preferred method of passing loosely captured suture 300 is alsoprovided and illustrated in FIG. 34. The method 300 comprises the step310 of diverging a pair of jaw members of a suture passing device fromeach other by translating a jaw assembly distally with respect to ahollow shaft to cause the outwardly biased jaw members to exit a distalneedle tip. This step 310 creates a preferably flared-out capture spacefor receiving a portion of suture. This steps 310 also comprisesdiverging each of the jaw members away from an axis defined by theshaft.

In step 320, the suture passing device is moved to surround a suturewith the open jaw members. In step 320, the suture would be disposedwithin a suture capture space that is defined between the two divergingjaw members and preferably shaped as a funnel.

In step 330, the jaw assembly is retracted with respect to the tube suchthat the inner wall of the tube causes the jaw members to convergetoward each other.

In step 340, the jaw members are moved to a closed configuration so asto loosely capture the suture and while allowing the loosely capturedsuture to slide.

In step 350, the loosely captured suture is retracted into the tube in apreferred range of 1 mm to 15 mm from a blade tip of the shaft.

In step 360, the suture is released when the jaw members are moved to anopen configuration. In the preferred method, the suture is notimmediately released as soon as a distal portion of the jaw membersexits the shaft. Instead, the suture is preferably retained for a shortdistance of after the suture capturing mechanism exits the lumen of theshaft.

Terms such as “top,” “bottom,” “front,” “rear,” “above,” “below” and thelike as used in this disclosure should be understood as referring to anarbitrary frame of reference, rather than to the ordinary gravitationalframe of reference. Thus, a top surface, a bottom surface, a frontsurface, and a rear surface may extend upwardly, downwardly, diagonally,or horizontally in a gravitational frame of reference. Similarly, anitem disposed above another item may be located above or below the otheritem along a vertical, horizontal or diagonal direction; and an itemdisposed below another item may be located below or above the other itemalong a vertical, horizontal or diagonal direction. While some featuresare shown facing away from gravity, it will be understood that featurescan be rotated or positioned perpendicular to gravity and work to hold,knot, or cut a suture in the same way as shown.

The word “exemplary” is used herein to mean “serving as an example orillustration.” Any aspect or design described herein as “exemplary” isnot necessarily to be construed as preferred or advantageous over otheraspects or designs.

All structural and functional equivalents to the elements of the variousaspects described throughout this disclosure that are known or latercome to be known to those of ordinary skill in the art are expresslyincorporated herein by reference and are intended to be encompassed bythe claims. Moreover, nothing disclosed herein is intended to bededicated to the public regardless of whether such disclosure isexplicitly recited in the claims. No claim element is to be construedunder the provisions of 35 U.S.C. § 112, sixth paragraph, unless theelement is expressly recited using the phrase “means for” or, in thecase of a method claim, the element is recited using the phrase “stepfor.” Furthermore, to the extent that the term “include,” “have,” or thelike is used in the description or the claims, such term is intended tobe inclusive in a manner similar to the term “comprise” as “comprise” isinterpreted when employed as a transitional word in a claim.

Many alterations and modifications may be made by those having ordinaryskill in the art without departing from the spirit and scope of theinvention. Therefore, it must be understood that the illustratedembodiments have been set forth only for the purposes of examples andthat they should not be taken as limiting the invention as defined bythe following claims. For example, notwithstanding the fact that theelements of a claim are set forth below in a certain combination, itmust be expressly understood that the invention includes othercombinations of fewer, more or different ones of the disclosed elements.

The words used in this specification to describe the invention and itsvarious embodiments are to be understood not only in the sense of theircommonly defined meanings, but to include by special definition in thisspecification the generic structure, material or acts of which theyrepresent a single species.

The definitions of the words or elements of the following claims are,therefore, defined in this specification to not only include thecombination of elements which are literally set forth. In this sense itis therefore contemplated that an equivalent substitution of two or moreelements may be made for any one of the elements in the claims below orthat a single element may be substituted for two or more elements in aclaim. Although elements may be described above as acting in certaincombinations and even initially claimed as such, it is to be expresslyunderstood that one or more elements from a claimed combination can insome cases be excised from the combination and that the claimedcombination may be directed to a subcombination or variation of a subcombination.

Insubstantial changes from the claimed subject matter as viewed by aperson with ordinary skill in the art, now known or later devised, areexpressly contemplated as being equivalently within the scope of theclaims. Therefore, obvious substitutions now or later known to one withordinary skill in the art are defined to be within the scope of thedefined elements.

The claims are thus to be understood to include what is specificallyillustrated and described above, what is conceptually equivalent, whatcan be obviously substituted and also what incorporates the essentialidea of the invention.

What is claimed is:
 1. A suture passing device, comprising: a handle; ashaft coupled to the handle, the shaft having a shaft axis defining alumen, the shaft comprising a distal tip; a jaw assembly housed withinthe shaft, the jaw assembly comprising a first jaw member and a secondjaw member, the first jaw member and the second jaw member being movablewith respect to each other between a closed position and an openposition; and an actuating mechanism coupled to the jaw assembly andconfigured to move the jaw assembly between the closed position and theopen configuration, wherein the first jaw member and the second jawmember are biased away from each other when the actuating mechanismmoves the jaw assembly distally with respect to the shaft such thatfirst jaw member and the second jaw member each diverge from the shaftaxis when exiting the shaft; the first jaw member and the second jawmember are moved to the closed position when the actuating mechanism ismoved to retract the jaw assembly proximally with respect to the shaft;and when a suture is disposed between the first jaw member and thesecond jaw member, a captured portion of the suture is moved inside thelumen a distance from about 10 mm to at least 45 mm from the distal tip.2. The device of claim 1, wherein the suture capturing mechanismcomprises teeth.
 3. The device of claim 1, wherein the suture capturingmechanism comprises: a first plurality of pointy teeth included in thefirst jaw member to form a first scalloped edge; and a second pluralityof pointy teeth included in the second jaw member to form a secondscalloped edge.
 4. The device of claim 3, wherein the first plurality ofteeth is nestable with the second plurality of teeth when the jawassembly is in the closed configuration.
 5. The device of claim 1,wherein the shaft comprises a bent shaft portion.
 6. The device of claim1, wherein the sharp distal tip comprises a blade tip.
 7. The device ofclaim 1, wherein the jaw assembly further comprises: a third jaw memberstacked on and movable in unison with the first jaw; and a fourth jawmember stacked on and movable in unison with the second jaw, wherein thethird jaw and the fourth jaw converge and diverge from each other inunison with the first jaw and second jaw.
 8. The device of claim 1,wherein the jaw assembly further comprises a second loose suturingcapturing mechanism.
 9. The device of claim 1, wherein the jaw assemblycomprises a cutout proximal to the suture capturing mechanism.
 10. Thedevice of claim 1, wherein the jaw assembly comprises a thickness in therange of 0.4 mm to 4.0 mm.
 11. The device of claim 10, wherein: the jawassembly comprises an exterior and the shaft comprises an interior shaftsurface; and a gap between the exterior of the jaw assembly and theinterior shaft surface is less than 1 mm.
 12. A suture passing device,comprising: a handle; a shaft coupled to the handle, the shaft having ashaft axis defining a lumen, the shaft comprising a distal tip; a jawassembly housed within the shaft, the jaw assembly comprising a firstjaw member and a second jaw member, the first jaw member and the secondjaw member being movable with respect to each other between a closedposition and an open position, the jaw assembly comprising a push-pullsuture capturing mechanism; and an actuating mechanism coupled to thejaw assembly and configured to move the jaw assembly between the closedposition and the open configuration, wherein the first jaw member andthe second jaw member are biased away from each towards the openposition and moved to the open position when the actuating mechanismmoves the jaw assembly distally with respect to the shaft such thatfirst jaw member and the second jaw member each diverge from the shaftaxis when exiting the shaft; the first jaw member and the second jawmember are moved to the closed position when the actuating mechanism ismoved to retract the jaw assembly proximally with respect to the shaft;the push-pull suture capturing mechanism comprises a set of teeth formedon the first jaw member and second jaw member; and the set of teeth onthe first jaw member and the second jaw member includes a kerf forming aspace therebetween when the jaw assembly is in the closed position. 13.The device of claim 12, wherein the shaft comprises a bent shaftportion.
 14. The device of claim 12, wherein the jaw assembly furthercomprises a second loose suturing capturing mechanism.
 15. The device ofclaim 12, wherein the jaw assembly comprises a cutout proximal to thepush-pull suture capturing mechanism.
 16. The device of claim 12,wherein the jaw assembly further comprises: a third jaw member stackedon the first jaw; and a fourth jaw member stacked on the second jaw,wherein the third jaw and the fourth jaw converge and diverge from eachother in unison with the first jaw and second jaw.
 17. A suture passingdevice, comprising: a handle; a shaft coupled to the handle, the shafthaving a shaft axis defining a lumen, the shaft comprising a distal tip;a jaw assembly housed within the shaft, the jaw assembly comprising afirst jaw member and a second jaw member, the first jaw member and thesecond jaw member being movable with respect to each other between aclosed position and an open position; a first set of teeth at a distalend of the first jaw member; a second set of teeth at a distal end ofthe second jaw member; a void, formed proximal to the first set of teethand the second set of teeth, between the first jaw member and the secondjaw member when in the closed position; a cutout formed along alongitudinal length of a jaw ribbon disposed proximal to the void, thefirst jaw member and the second jaw member extending from a proximal endof the jaw ribbon; and an actuating mechanism coupled to the jawassembly and configured to move the jaw assembly between the closedposition and the open configuration, wherein the first jaw member stackand the second jaw member stack are biased away from each towards theopen position and moved to the open position when the actuatingmechanism moves the jaw assembly distally with respect to the shaft suchthat the first jaw member stack and the second jaw member stack eachdiverge from the shaft axis when exiting the shaft; and the first jawmember stack and the second jaw member stack are moved to the closedposition when the actuating mechanism is moved to retract the jawassembly proximally with respect to the shaft.
 18. The device of claim17, wherein the first set of teeth and the second set of teeth meshtogether in the closed position.
 19. The device of claim 17, when asuture is disposed between the first jaw member and the second jawmember, a captured portion of the suture is moved inside the lumen adistance from about 10 mm to at least 45 mm from the distal tip.